Application of nalmefene in laparoscopic hysterectomy
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摘要: 目的探讨盐酸纳美芬在腹腔镜全子宫切除术静脉麻醉中对舒芬太尼的镇痛作用和呼吸抑制作用及不良反应的拮抗效果。方法选择择期在全凭静脉麻醉下行腹腔镜全子宫切除术的患者60例,ASAⅠ～Ⅱ级。采用随机数字表法分为3 组,每组20例。纳美芬术后组手术结束后5 min静脉注射纳美芬,纳美芬术前组麻醉诱导前5 min静脉注射纳美芬,空白对照组不用盐酸纳美芬干预。记录患者自主呼吸恢复时间,睁眼时间,拔管时间,术后1、8、24 h视觉模拟镇痛评分（VAS）,拔管后5、30、60 min Ramsay镇静评分及躁动、恶心呕吐、呼吸抑制等不良反应的发生情况。结果纳美芬术后组、纳美芬术前组患者术后自主呼吸恢复时间、睁眼时间、拔管时间、各时间点的Ramsay镇静评分及不良反应发生率均比空白对照组少,差异有统计学意义（P<0.05）；而纳美芬术后组和纳美芬术前组上述指标的差异无统计学意义（P>0.05）。3组在术后各时间点VAS的差异无统计学意义（P>0.05）。结论盐酸纳美芬能够拮抗舒芬太尼的呼吸抑制作用,降低不良反应的发生率,获得较好的催醒效果,且对舒芬太尼的术后镇痛作用不产生明显的影响。Abstract: ObjectiveTo investigate the influence of nalmefene hydrochloride on the analgesic effects, respiratory depression and adverse reaction of sufentanil during laparoscopic hysterectomy under intravenous anesthesia. MethodsSixty ASA I-II patients who were scheduled to undergo laparoscopic hysterectomy under intravenous anesthesia were enrolled. They were randomly divided into three groups (n=20): a nalmefene postoperative injection group giving nalmefene 5 min after the end of surgery, a nalmefene preoperative injection group injected with nalmefene 5 min before anesthesia induction and a blank control group without nalmefene injection. The recovery time of spontaneous breathing, time to open eyes, extubation time, visual analogue analgesia score (VAS) at 1, 8 and 24 h after surgery, Ramsay scores 5, 30 and 60 min after extubation and adverse reactions such as restlessness, nausea and vomiting, and respiratory depression were recorded. ResultsCompared with the black control group, the nalmefene postoperative and preoperative injection groups showed remarkable decreases in postoperative spontaneous breathing recovery time, time to open eyes, extubation time, Ramsay scores at difference time points and adverse reactions (P<0.05). There was no significant difference as to the above indexes between the nalmefene postoperative and preoperative injection groups (P>0.05). No significant difference in VAS among the three groups at all time points (P>0.05). ConclusionsNalmefene hydrochloride can antagonize the respiratory depression and reduce the incidence of adverse reactions after sufentanil administration, without significant effects on postoperative analgesic effects.
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